Addressing Appropriateness of Medications in the 65 Years and Older Patients in the Outpatient Setting
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Addressing Appropriateness of Medications in the 65 Years and Older Patients in the Outpatient Setting


Background: The use of many medications is common among those over 65 and older living inthe United States. However, the increased number of medications used, especially prescription medications, results in harmful consequences: prescription of potentially inappropriate medications (PIMs) and medications without clinical indications. The World Health Organization reported that four out of ten patients are harmed in outpatient settings because of unsafe healthcare-related to wrong prescriptions. There are works of literature suggesting that healthcare providers (HCP) often do not follow clinical practice guidelines. Objectives: This quality improvement project implemented an NP-led educational intervention to decrease the frequency of potentially inappropriate medications in older patients in the outpatient setting. The intervention provided the healthcare providers a mechanism to address PIMs. Methods: This pre-post quality improvement project used a nurse practitioner-led educational intervention and applied an evidence-based screening tool to manage PIMs. This study was conducted between November 2020 and March 2021. Quantitative measurements were used to evaluate the intervention's effects in addressing PIMs in the outpatient setting in eight weeks. Descriptive statistics were used to characterize variable distributions. The t-tests estimated group comparisons between pre-educational intervention and post-educational intervention number of inappropriate medications, the proportion of patients with inappropriate medications, patients with duplicated medications, and medications that had matching diagnoses. Results: There were a total of 166 patients' medical records reviewed. The mean age for all the patients was 73.2, 49.4%, and the majority were female and predominantly Hispanic (50.6%). Throughout the entire period, reviewed medical records showed that the three most prevalent diagnoses were hypertension (63.9%), hyperlipidemia (49.4%), and type 2 diabetes mellitus (43.4%). There was no observed statistically significant difference in the number of inappropriate medications between pre-and post-intervention. However, there was a trend of improvement in the number of patients receiving duplicated medications from pre-intervention to post-intervention. Conclusion: Although there was no significant decrease in the frequency of inappropriate medications in the eight weeks, issues associated with PIMs in the multimorbid older patients require further quality improvement projects. A longer process evaluation period is necessary to provide HCPs the time to adapt and use evidence-based screening tools and increase patient-provider consistency in decreasing PIMs.

Keywords: inappropriate medications, older patients, outpatient setting, nurse practitioner-ledintervention.

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